- What is a hysterectomy?
- What are the most common reasons that a woman might require a hysterectomy?
- What are the different types of hysterectomy performed?
- What is a laparoscopy?
- What is a laparoscope?
- Will other organs (cervix, fallopian tubes, ovaries) in addition to my uterus, need to be removed and how will this affect my health after surgery?
- Should I get a second opinion?
- What questions should I ask my surgeon during my consultation?
- How do I prepare for surgery?
- How will I feel after surgery?
- What can I expect in terms of recovery after my procedure?
- What are the risks and complications associated with laparoscopic hysterectomy?
- What are some factors that my doctor may consider for a laparoscopic hysterectomy?
1. What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus, also known as the womb. It is a muscular, pear-shaped organ that is part of the female reproductive system. Sometimes, your doctor will also recommend removing the cervix which connects the uterus to the vagina. Your doctor may also recommend removal of the ovaries where eggs are formed and the fallopian tubes which the eggs travel through to get to the uterus during a woman's childbearing years.
2. What are the most common reasons that a woman might require a hysterectomy?
Fibroids - Uterine fibroids are common non-cancerous tumors in the uterus comprised of muscle and fibrous tissue. Fibroids grow from the wall of the uterus. As many as 80% of all women could have uterine fibroids, although the majority have no symptoms. One in four women with uterine fibroids experience symptoms severe enough to require treatment. 
Endometriosis - Endometriosis is a condition in which cells usually found inside the uterus grow on the surface of the uterus or on other organs in the abdomen. This condition can be painful and can result in irregular bleeding or even infertility. It is estimated that up to 40% of women with endometriosis will have difficulty conceiving. The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn't correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways. 
Uterine Prolapse - Uterine prolapse occurs when the uterus has descended from its original position in the pelvis farther down into the vagina. Muscles and ligaments that make up the pelvic floor hold the uterus in place. Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, no longer providing enough support for the uterus. As a result, the uterus descends into the vaginal canal. Uterine prolapse often affects postmenopausal women who've had one or more vaginal deliveries. Damage sustained by supportive tissues during pregnancy and childbirth, plus the effects of gravity, loss of estrogen and repeated straining over the years, can weaken pelvic floor muscles and tissues and lead to uterine prolapse. 
Abnormal Uterine Bleeding - Abnormal uterine bleeding is defined as:
- Bleeding between periods
- Bleeding heavier or for long periods of time (also referred to as menorrhagia)
- Bleeding after menopause
Abnormal uterine bleeding can occur at any age and can be the result of many different causes such as hormonal imbalance or the presence of a polyp or fibroids. 
Uterine cancer - Uterine sarcoma is a cancer of the muscle and supporting tissues of the uterus. Sarcomas are cancers that start from tissues such as muscle, fat, bone, and fibrous tissue. An estimated 42,160 new cases of uterine cancer were diagnosed in 2009. Treatment options are available. 
Endometrial cancer - Endometrial cancer starts in the inner lining of the uterus, which is called the endometrium. The endometrium changes during a woman's menstrual cycle. In the beginning part of the cycle, the lining gets thicker in case the woman becomes pregnant. If there is no pregnancy, the tissue is shed from the uterus and becomes the menstrual flow. Most cancers of the uterus start in the endometrium and are called endometrial carcinomas. 
Cervical cancer - Cervical cancer begins in the lining of the cervix. The cancer forms slowly. At first some cells begin to change from normal to pre-cancer and then to cancer. The change in cells is called dysplasia. Dysplasia can be found by a Pap test and can sometimes be treated to prevent cancer. The American Cancer Society reports that in 2009, there were 11,270 new cases of invasive cervical cancer, which is cancer that has spread beyond the cervix. 
3. What are the different types of hysterectomy performed?
Total Abdominal Hysterectomy (TAH) - The surgeon makes an incision approximately five inches long in the abdominal wall in a total abdominal hysterectomy (TAH), cutting through skin and connective tissue to reach the uterus. The cut is either vertical, from just below the navel to just above the pubic bone, or horizontal, across the top of the public bone (This is also referred to as a bikini-line incision).
Vaginal - A vaginal hysterectomy is performed through a small incision at the top of the vagina. The uterus is separated from its connecting tissue and blood supply and removed through the incision at the top of the vagina.
Laparoscopic Supracervical Hysterectomy (LSH) - An LSH is a minimally-invasive procedure where three to five tiny incisions are made in the abdomen into which a laparoscope and surgical instruments are inserted. The uterus is removed through these small incisions and the fallopian tubes and/or ovaries may or may not be removed. In this procedure, the cervix is left intact.
Total Laparoscopic Hysterectomy (TLH) - A TLH is another minimally invasive option that is similar to the LSH procedure. The main difference is the cervix is removed with the uterus. The fallopian tubes and/or ovaries may or may not be removed.
LESS Hysterectomy (LESS) - A LESS Hysterectomy is similar to a laparoscopic hysterectomy. The main difference is that a LESS hysterectomy is performed through one single incision in the navel instead of 3-5 smaller incisions in the abdomen.
4. What is a laparoscopy?
Laparoscopy is a surgical procedure in which the surgeon makes a small incision in the patient's abdomen which allows the insertion of an instrument called a laparoscope. Using this instrument allows the surgeon to see the inside of the abdomen.
5. What is a laparoscope?
A laparoscope is a thin, long, rigid tube in which light travels along glass fibers to light up internal organs. A periscope-like attachment allows the surgeon to see into the abdomen and pelvis. Other instruments used with the laparoscope allow the surgeon to take photographs, obtain biopsies of tissue and now, with the addition of the laser, to cut, coagulate or vaporize tissue.
6. Will other organs (cervix, fallopian tubes, ovaries) in addition to my uterus, need to be removed and how will this affect my health after surgery?
LSH leaves the cervix intact whereas TLH does not. Some surgeons believe that leaving the cervix intact may reduce the risk of urinary incontinence, pelvic support problems, and decreased sexual stimulation. Not all women are candidates for the LSH procedure. It is best to talk with your physician about your options. Depending on your medical diagnosis, your fallopian tubes and ovaries may need to be removed. The removal of your ovaries may lead to symptoms associated with menopause - hot flashes, insomnia, irritability or vaginal dryness. These symptoms may be reduced by alternative therapies. Ask your physician about your options.
7. Should I get a second opinion?
While you may have concerns about offending your primary gynecologist with whom you have had a longstanding relationship, it's perfectly acceptable and highly recommended to get a second opinion before undergoing surgery. Your gynecologist will understand that you are being thorough and researching all of your options. When obtaining your second opinion, be sure to have all of your records with you but also request an exam. Verify whether the first recommendation was appropriate and if there are alternative options available to you.
- What type of hysterectomy is appropriate for my symptoms?
- Am I a candidate for laparoscopic surgery? If not, why?
- How many laparoscopic hysterectomies do you perform a year?
- Will other organs (cervix, fallopian tubes, ovaries) in addition to my uterus, need to be removed and how will that affect my health after surgery?
- What type of anesthesia is necessary for this surgery?
- What should I do to prepare for the surgery?
- Will I have pain after surgery?
- Will I have scars, how many and how large will they be?
- How long will I need to stay in the hospital?
- How long is the average recovery time for my type of hysterectomy?
- How soon will I be able to return to work, exercise, and sexual activity?
- What are the risks associated with laparoscopic hysterectomy?
- What are the risks associated with traditional abdominal hysterectomy?
- Why is a laparoscopic hysterectomy appropriate or not appropriate?
- Why is a traditional abdominal hysterectomy appropriate or not appropriate?
9. How do I prepare for surgery?
During your pre-op consultation with your surgeon, you will be given instructions on how to prepare for your procedure. You should make sure you understand these instructions and follow them specifically before surgery.
Surgeons' pre-op requirements will differ. Some surgeons will require a bowel prep such as an enema or bowel clean-out. In addition, most surgeons will require you to stop eating and drinking up to 12 hours before surgery. Another common requirement is for all finger and toe nail polish to be removed. Again, every surgeon's requirements will differ and you need to consult with your specific physician before surgery.
10. How will I feel after surgery?
Following any laparoscopic procedure, some discomfort is normal and to be expected. Patients commonly report pain in the shoulders, neck and abdomen. This may occur because gas used during the procedure to expand the abdomen cannot be fully removed. These symptoms usually resolve within 12-24 hours with bed rest.
The incision and stitches may be tender for a few days. Most of these minor discomforts subside quickly. While each patient is different, most will recover within a few hours or a day after the procedure. Improvement is continuous.
Nausea may occur and can be related to abdominal distention and/or manipulation of the bowel during the procedure. Some patients develop post-surgical nausea from anesthesia.
11. What can I expect in terms of recovery after my procedure?
Laparoscopic Hysterectomies (LSH, TLH, LESS Hysterectomy, and LAVH) are less invasive procedures and may be done as an outpatient procedure or may require a hospital stay of up to one day. The recovery time is usually up to 2-3 weeks, which allows patients to return to normal activity quicker than traditional hysterectomy. Total abdominal hysterectomies require a hospital stay of up to five or six days and a recovery of up to six weeks.
12. What are the risks and complications associated with laparoscopic hysterectomy?
There is always a probability that your laparoscopic hysterectomy may be converted to an open procedure if there are unforeseen complications during your procedure such as difficult anatomy or excessive bleeding. While major risks are rare, all surgery should be considered carefully. With laparoscopic surgery, as with all surgery, there are the typical risks of reactions to medications or problems resulting from the anesthesia, bleeding, infection, problems breathing, blood clots in the veins or lungs, inadvertent injury to other organs or blood vessels near the uterus, and even death, which is rare. The risk for serious complications depends on the reason the surgery is needed and your medical condition and age, as well as on the experience of the surgeon and anesthesiologist. Ask your doctor what you should expect after surgery, as well as the risks that may occur with surgery.
13. What are some factors that my doctor may consider for a laparoscopic hysterectomy?
There are a variety of factors that your doctor may consider before making the recommendation for a laparoscopic hysterectomy. Some of these factors may include your weight, age, prior surgeries, and underlying medical conditions. Discuss these factors with your doctor to understand how they might impact your surgery.
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